DIAGNOSIS, MANAGEMENT AND OUTCOME OF HEART DISEASE IN SUDANESE PATIENTS
|
|
- Elizabeth Gibson
- 5 years ago
- Views:
Transcription
1 434 E AST AFRICAN MEDICAL JOURNAL September 2007 East African Medical Journal Vol. 84 No. 9 September 2007 DIAGNOSIS, MANAGEMENT AND OUTCOME OF CONGENITAL HEART DISEASE IN SUDANESE PATIENTS K.M.A. Sulafa, FRCPCH, FACC, Department of Paediatric Cardiology, Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan and Z. Karani, FCS-SA, MMed, Department of Cardiac Surgery, Sudan Heart Centre, Khartoum, Sudan Request for reprints to: Dr. K.M.A. Sulafa, Department of Paediatric Cardiology, Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan DIAGNOSIS, MANAGEMENT AND OUTCOME OF HEART DISEASE IN SUDANESE PATIENTS K.M.A. SULAFA and Z. KARANI ABSTRACT Objectives: To describe the diagnosis, management and outcome of patients with congenital heart disease seen at Sudan Heart Centre. Design: A prospective follow up of all patients diagnosed as congenital heart disease. Setting: Sudan Heart Centre. Subjects: All children and adults with congenital heart disease seen at Sudan Heart Centre by one paediatric cardiologist from July 2004 to June Results: Five hundred and twenty two patients were evaluated, 435 had abnormal hearts. The median age was 48 months (one day to sixty five years). Congenital heart disease constituted 87% and acquired heart disease and rhythm disorders 13%. The frequency of the different cardiac heart disease was described and in general did not differ from that reported in the literature except for Ebstein anomaly which was noted to be four times more frequent than reported. Cardiac catheterisation was done for 81 patients, for diagnosis in 61 (75%) and for intervention in 20 (25%) patients. Balloon dilatation, atrial septostomy septal defect and patent ductus arteriosus closure with the help of a visiting team, the success rate for interventions was 95%. Surgery was done for 125 patients. Seventy three operations were done by the local team and 52 by the visiting team. The 30 day operative mortality was 8.3%. Conclusion: Paediatric cardiac service in Sudan in echocardiography and cardiac catheterisation is growing. Cardiac surgical results are comparable to the literature. INTRODUCTION Sudan Heart Centre (SHC) is a cardiac referral centre established in the year 2000 as one of the first few centres of its kind in Sudan. In the initial period till the year 2001 the service was delivered to children by adult cardiologists. Paediatric cardiology was first started in 2001 by one part-time paediatric cardiologist. A paediatric cardiac surgeon joined the centre in In July 2004 a full-time paediatric cardiologist joined the centre and established the paediatric catheterisation service. The purpose of this study was to review the diagnoses (echocardiographic and cardiac catheterisation), management (medical, catheter based and surgical) and its outcome for children seen at the SHC. MATERIALS AND METHODS All paediatric patients and adults with congenital heart disease (CHD) seen at SHC from July 2004 to June 2005 were included in the study. Patients were evaluated clinically and by echocardiography. Cardiac catheterisation was done when indicated. Echocardiography: A complete 2-dimensional /Doppler echo study was done for each patient using MEGAS (Esaote) machine. A standard
2 September 2007 EAST AFRICAN MEDICAL JOURNAL 435 technique (segmental approach) using the four echo views (subcostal, parasternal long and short and suprasternal) was applied. Sedation with chloral hydrate (50mg/kg/dose) was used in infants who needed detailed initial and/or preoperative studies. A written report with printed pictures was initially used for documentation but recently a digital archiving system was established and patients going for surgery had their echo studies recorded digitally. Cardiac catheterisation: Indications for cardiac catheterisation were: (i) Diagnosis of anatomical lesions not well delineated by echo. (ii) Diagnosis of haemodynamic abnormalities. (iii) Treatment of anomalies amenable to interventional catheterisation. Cardiac catheterisation was done as day case for diagnostic purposes in older children. Infants and children undergoing interventions were admitted overnight for monitoring. General anaesthesia was used for the latter group of patients while for the first group ketamine was used for sedation. Interventional septal defect occlusion was done by a visiting team, while pulmonary valve dilatation, atrial septostomy and patent ductus arteriosus occlusion was done by the local team. Cardiac surgery: Patients selected for surgery were discussed with the cardiac surgeon in a joint meeting. Our policy is to perform definitive intracardic repair of congenital heart defects (where indicated) in patients weighing more than six kilograms; below six kilograms our local surgical team performs palliative procedures and definitive closure of patent ductus arteriosus and coarctation of aorta. Open heart surgery for children weighing below six kilograms and complex repairs were done by a visiting team lead by a paediatric cardiac surgeon. Statistical methods: Patients data were entered into an SPSS computer program and frequency tables were generated. RESULTS In the study period 522 patients were evaluated. The age ranged from one day to 65 years with a median of 48 months. Male to female ratio was 1.3:1. Four hundred and thirty five patients (80%) had abnormal cardiac examination and 87 (20%) were normal. CHD constituted 378 (87%) and acquired heart disease and rhythm disorders 57 (13%). Rheumatic heart disease was diagnosed in 36 patients (8.2%). Diagnosis of congenital heart disease: Table 1 shows the frequency of CHD diagnosed on echo and Table 2 the frequency of acquired heart disease and rhythm disorders. The most common acyanotic anomalies were ventricular septal defect (16.1%), atrioventricular septal defect (8.6%), atrial septal defect (6.2%) and patent ductus arteriosus (4.6%). Tetralogy of Fallot was the most common cyanotic anomaly (17.7%) followed by transposition of great arteries (6.6%) and tricuspid atresia (3.2%). Rhythm disorders included three patients with congenital atrioventricular block and two patients with supraventricular tachycardia. Cardiac catheterisation: A total of 81 cardiac catheterisations were done in the study period. Table 3 shows the indications for cardiac catheterisation and Table 4 the outcome and disposition of patients who underwent catheterisation. Common indications for diagnostic catheterisation were Tetralogy of Fallot to delineate the pulmonary artery anatomy in 16 (23%) patients and large ventricular septal defect to measure pulmonary vascular resistance in 12 (15%) patients. In two patients the cardiac catheterisation diagnosis was different from echo. In the first patient catheterisation corrected the echo diagnosis of total anomalous pulmonary venous return to the diagnosis of transposition of great arteries with normal pulmonary venous return. The second patient had double outlet right ventricle on echo and catheterisation revealed that there was, in addition, severe pulmonary valve stenosis. Twenty patients
3 436 E AST AFRICAN MEDICAL JOURNAL September 2007 Table l Congenital heart disease diagnosed on echo Lesion No. (%) Ventricular septal defect Small 22 Large 46 Atrial septal defect Secundum 24 Sinus venosus 2 Unroofed coronary sinus 1 Patent ductus arteriosus Small 2 Large 18 Atrioventricular septal defect Partial 16 Complete 10 Unbalanced 9 With pulmonary valve stenosis 2 Pulmonary valve stenosis 26 6 Aortic stenosis Valvular 1 Sub-valvular 4 Supra-valvular 1 Coarctation of aorta Anomalous pulmonary venous drainage Ebstein anomaly Tetralogy of Fallot Tetralogy of Fallot with absent pulmonary valve 2 Transposition of great arteries Intact ventricular septum 8 Ventricular septal defect 10 Ventricular septal defect /pulmonary stenosis 11 Corrected transposition of great arteries Tricuspid atresia With ventricular septal defect 3 With ventricular septal defect/ pulmonary valve stenosis 10 With transposition of great arteries 1 Truncus arteriosus Double inlet left ventricle Double outlet right ventricle Subaortic ventricular septal defect 5 Subpulmonary ventricular septal defect 4 Doubly committed ventricular septal defect 2 Non-committed ventricular septal defect 1 Pulmonary atresia with ventricular septal defect Isometric heart Mitral valve anomalies Total
4 September 2007 EAST AFRICAN MEDICAL JOURNAL 437 Table 2 Acquired heart diseases and rhythm disorders No. (%) Rheumatic heart disease Mitral regurgitation Mitral stenosis Aortic regurgitation Mitral and aortic regurgitation Cardiomyopathy Pulmonary hypertension with no CHD Tumours/miscellaneous Rhythm disorders Total Table 3 Indications for cardiac catheterisation Indication No. (%) Preoperative assessment Postoperative assessment 8 10 Intervention Other 3 4 Total Table 4 Outcome of cardiac catheterisation Outcome measure No. (%) Suitable for corrective surgery Suitable for high risk surgery Suitable for palliation 9 11 Not suitable for surgery 6 7 Successful intervention Unsuccessful intervention For re-do surgery 5 6 Conservative treatment 4 5 Insufficient data Total underwent interventional catheterisation including eleven cases of device occlusion (six patients with patent ductus arteriosus, three with atrial septal defect and two with ventricular septal defects). These device occlusions were done in SHC with the help of a visiting team. Other interventions were pulmonary valve dilatation (n = 6) and balloon atrial septostomy (n = 3). One patient had an unsuccessful trial of balloon dilatation for critical pulmonary valve stenosis. This was a syndromic infant with hypoplastic pulmonary arteries where we could not place the exchange wire in the distal pulmonary
5 438 E AST AFRICAN MEDICAL JOURNAL September 2007 artery branch. Complications of catheterisation included one mortality in a ten year old boy with pulmonary atresia and ventricular septal defect with major aortopulmonary collaterals who had multiple cerebrovascular accidents. His oxygen saturation before the procedure was 40% and he developed cardiac arrest with induction of anaesthesia. Two patients developed respiratory depression needing intubations and two patients had minor bleeding. Outcome: Table 4 shows the outcome of patients who had cardiac catheterisation, Table 5 shows the overall outcome of patients, Table 6, the outcome of patients who had surgery and Table 7, the details of operations done by the local surgical team. Out of one hundred and eighty one patients referred for surgery, only one hundred and twenty four were operated on. Seventy two operations were done by the local team and fifty two by the visiting team. The local surgeons performed fifty eight corrective intracardiac procedures and fourteen closed procedures of which six were palliative. The most common open heart operations were 20 complete repair of Tetralogy of Fallot and 15 ventricular septal defect closure; three of the ventricular septal defect cases had additional procedures: one aortic valve replacement for severe aortic regurgitation, one mitral valve repair for an isolated anterior mitral valve cleft and one relief of pulmonary stenosis in a patient with corrected transposition of great arteries/pulmonary valve stenosis. The median weight was kgs (range = 3 75 kgs) and the median age was eight years (range = years). The total operative mortality was six (8.3%). Of these, five cases were corrective heart procedures: one Tetralogy of Fallot repair, three complex ventricular septal defect closures and one atrioventricular septal defect/pulmonary stenosis repair while one patient had a palliative operation (Modified Blalock-Taussig Shunt). For the visiting team the median age was 19.8 months (range = 1 month 14 years) and the median weight was 7.1 kgs (range = 3 45). The mortality rate was nine (17.3%), seven were open heart procedures and included one transposition of great arteries with abnormal coronary anatomy, two obstructed total anomalous pulmonary venous drainage, one of them was associated with transposition of great arteries, one atrioventricular septal defect with Tetralogy of Fallot, one Tetralogy of Fallot with small pulmonary artery branches, one huge patent ductus arteriosus with pulmonary stenosis in a three kilogram infant, conduit change for a child with repaired truncus arteriosus. The two closed cases included one modified Blalock-Taussig Shunt and one complex Glenn procedure in an infant with isomeric heart. Table 5 Outcome of patients with heart disease Outcome No. (%) Medical treatment Corrective surgery Palliative surgery 28 7 Catheter treatment 19 5 Inoperable Late Complex Elective surgery No treatment needed 29 8 Awaiting surgery Expired Unknown Total
6 September 2007 EAST AFRICAN MEDICAL JOURNAL 439 Table 6 Outcome of surgery for congenital heart disease Surgery No. No. of deaths (%) Mortality Local team Open heart Closed heart Total International team Open heart Closed heart Total Table 7 Operations for congenital heart disease done by the local team Type of Surgery No. Tetralogy of Fallot repair 20 Ventricular septal defect closure 15 Atrioventricular septal defect repair 6 Patent ductus arteriosus closure 7 Modified Blalock-Taussig Shunt 5 Secundum atrial septal defect closure 3 Secundum atrial septal defect /Pulmonary stenosis repair 3 Relief of subaortic aortic stenosis 4 Partial anomalous pulmonary venous drainage (two with sinus 4 venous atrial septal defect) Ascending aorta to pulmonary artery shunt 1 Relief of supra-valvular aortic stenosis 1 Relief of pulmonary stenosis 1 Pulmonary artery band 1 Permanent pacemaker insertion 1 Total 72 DISCUSSION Management of children with heart disease is expensive as it needs specialised personnel and equipment. Working in developing countries where resources are limited and trained personnel scanty is a real challenge. Few studies were published about the incidence of congenital heart disease detected by echocardiography in Sudan. El Hag (1) looked at 179 patients from and found that CHD constituted 56% and rheumatic heart disease 39%. In Sudan, until the year 2001 echocardiography for children used to be done by adult cardiologists which leads to many limitations as the standard echo methodology (segmental approach) and nomenclature for congenital heart disease were usually not applied. During our study period we reviewed 40 echocardiograms for CHD done by adult colleagues and the diagnosis was incorrect in 45%, and incomplete in 30% of patients. Only in 25% the diagnosis was accurate and in all of these patients the diagnosis was either a ventricular or atrial septal defect (unpublished data), findings that are consistent with that of Stanger et al and Ward et al (2,3). In this study we described nineteen echo diagnoses with their subdivisions and their frequencies, many of these lesions had not to our
7 440 E AST AFRICAN MEDICAL JOURNAL September 2007 knowledge been investigated in Sudan. The frequency of most CHD did not differ from that published in the literature. However, for Ebstein anomaly we found a frequency of 2.1%, more than four times the reported frequency of 0.5% in the western literature (4). Rheumatic heart disease continued to be the leading cause of acquired heart disease in our region, a prevalence of 3/1000 was reported in Sudan in 1992 (5). Compared to El Hag (1) who reported a frequency of rheumatic heart disease of 39%, our frequency (8.2%) is much less which might reflect some improvement in socio-economic standards. Of the seven patients with cardiomyopathy, two had non-compaction of the ventricular myocardium; a cardiomyopathy that we recently reported in a large series in Saudi Arabia and we think is largely under-diagnosed (6). Indications for cardiac catheterisation did not differ from literature. Catheterisation corrected echo diagnosis only in two patients indicating the reliability of echo even for complex anomalies. Interventional catheterisation was first started by the adult cardiologist then taken over by the paediatric cardiologist. Visiting teams then helped starting a programme for device closure of atrial and ventricular septal defects and ductus arteriosus. Patent ductus arteriosus and atrial septal defect closure are being done but ventricular septal defect closure is a technically demanding procedure and is not planned at this time by the local team. Although the cost of these devices is high ( US Dollars) it is still comparable to the cost of surgery and non-surgical closure is now requested by many families. Only 69% of patients requiring surgery were operated on indicating a long waiting period which is directly proportional to the socio-economic status of the family. The total cost of surgery (4000 US Dollars) is too high for many families especially those with rheumatic heart disease. Funds had been raised that could mostly pay 50% of the cost. On the other hand 5% of our patients presented when they were already inoperable. This is not unexpected in a country where paediatric cardiac services just started but should alert the general paediatricians about the importance of early diagnosis. The institutional 30 day operative mortality of 8.3% for congenital heart operations is consistent with figures reported by Jenkins and Gauvreau (7) of 2.5% to 11.4% (median, 5.6%) for unadjusted mortality in twenty two large institutions in the United States. The patients who died were all in risk category 2; the risk-adjusted mortality for the latter category was 0% to 8.8% (median, 2.5%) as reported by Jenkens and Gauvreau (7) thus yielding an acceptable mortality for our patients. The visiting team helped to treat many children with small weight and do complex repairs like Rastelli repair, Ross-Kono procedure, arterial and atrial switch operations. In addition there was significant consolidation of the experience of our intensive care staff with management of this group of children. The relatively high mortality of the international team is directly related to the complexity of lesions of the patients who died. These operations were all done during three ten-day visits with the rate of two to three operations per day which added to the postoperative management difficulties. In conclusion, we managed to consolidate the service of paediatric cardiology at the SHC both in echocardiography and cardiac catheterisation. We can confidently perform definitive intracardiac repair of the most common congenital cardiac defects and palliate the more complex congenital cardiac defects in the well selected patients. REFERENCES 1. El Hag A.I. Pattern of congenital heart disease in Sudanese children. East Afr. Med. J. 1994; 71: Arthur Garcon J.R.J., Bricker T., Fisher D.J. and Neish S.R. The science and practice of pediatric cardiology, second edition. Williams and Wilkins Stanger P., Silverman N.H. and Foster E. Diagnostic accuracy of pediatric echocardiograms performed in adult laboratories. Amer. J. Cardiol. 1999; 83: Ward C.J. and Purdie J. Diagnostic accuracy of paediatric echocardiograms interpreted by individuals other than paediatric cardiologists. J. Paediat. Child Hlth. 2001; 7: Ibrahim-Khalil S., Elhag M., Ali E., et al. An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan. J. Epidemiol. Comm. Hlth. 1992; 46: Sulafa K.M.A. and Godman M.J. The variable clinical presentation of, and outcome for, noncompaction of the ventricular myocardium in infants and children, an under-diagnosed cardiomyopathy. Cardiol. Young. 2004; 14: Jenkins K.C. and Gauvreau K. Centre-specific differences in mortality: Preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J. Thorac. Cardiovasc. Surg. 2002; 124:
Pediatric Echocardiography Examination Content Outline
Pediatric Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 Anatomy and Physiology Normal Anatomy and Physiology 10% 2 Abnormal Pathology and Pathophysiology
More informationECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT
ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES
More informationA SURGEONS' GUIDE TO CARDIAC DIAGNOSIS
A SURGEONS' GUIDE TO CARDIAC DIAGNOSIS PART II THE CLINICAL PICTURE DONALD N. ROSS B. Sc., M. B., CH. B., F. R. C. S. CONSULTANT THORACIC SURGEON GUY'S HOSPITAL, LONDON WITH 53 FIGURES Springer-Verlag
More informationCommon Defects With Expected Adult Survival:
Common Defects With Expected Adult Survival: Bicuspid aortic valve :Acyanotic Mitral valve prolapse Coarctation of aorta Pulmonary valve stenosis Atrial septal defect Patent ductus arteriosus (V.S.D.)
More informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationCardiac Catheterization Cases Primary Cardiac Diagnoses Facility 12 month period from to PRIMARY DIAGNOSES (one per patient)
PRIMARY DIAGNOSES (one per patient) Septal Defects ASD (Atrial Septal Defect) PFO (Patent Foramen Ovale) ASD, Secundum ASD, Sinus venosus ASD, Coronary sinus ASD, Common atrium (single atrium) VSD (Ventricular
More informationCongenital heart disease: When to act and what to do?
Leading Article Congenital heart disease: When to act and what to do? Duminda Samarasinghe 1 Sri Lanka Journal of Child Health, 2010; 39: 39-43 (Key words: Congenital heart disease) Congenital heart disease
More informationSeptember 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical)
September 26, 2012 Philip Stockwell, MD Lifespan CVI Assistant Professor of Medicine (Clinical) Advances in cardiac surgery have created a new population of adult patients with repaired congenital heart
More informationAbsent Pulmonary Valve Syndrome
Absent Pulmonary Valve Syndrome Fact sheet on Absent Pulmonary Valve Syndrome In this condition, which has some similarities to Fallot's Tetralogy, there is a VSD with narrowing at the pulmonary valve.
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationThe complications of cardiac surgery:
The complications of cardiac surgery: a walk on the Dark Side? Prof Rik De Decker Red Cross Children s Hospital CME Nov/Dec 2011 http://www.cmej.org.za Why should you care? You are about to leave your
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationRecent technical advances and increasing experience
Pediatric Open Heart Operations Without Diagnostic Cardiac Catheterization Jean-Pierre Pfammatter, MD, Pascal A. Berdat, MD, Thierry P. Carrel, MD, and Franco P. Stocker, MD Division of Pediatric Cardiology,
More informationCongenital Heart Disease An Approach for Simple and Complex Anomalies
Congenital Heart Disease An Approach for Simple and Complex Anomalies Michael D. Pettersen, MD Director, Echocardiography Rocky Mountain Hospital for Children Denver, CO None Disclosures 1 ASCeXAM Contains
More informationA Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution
Original Article A Unique Milieu for Perioperative Care of Adult Congenital Heart Disease Patients at a Single Institution Ghassan Baslaim, MD, and Jill Bashore, RN Purpose: Adult patients with congenital
More information3/14/2011 MANAGEMENT OF NEWBORNS CARDIAC INTENSIVE CARE CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 WITH HEART DEFECTS
CONFERENCE FOR HEALTH PROFESSIONALS IRVINE, CA. MARCH 7, 2011 MANAGEMENT OF NEWBORNS WITH HEART DEFECTS A NTHONY C. CHANG, MD, MBA, MPH M E D I C AL D I RE C T OR, HEART I N S T I T U T E C H I LDRE N
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationMEDICAL SCIENCES Vol.I -Adult Congenital Heart Disease: A Challenging Population - Khalid Aly Sorour
ADULT CONGENITAL HEART DISEASE: A CHALLENGING POPULATION Khalid Aly Sorour Cairo University, Kasr elaini Hospital, Egypt Keywords: Congenital heart disease, adult survival, specialized care centers. Contents
More information5.8 Congenital Heart Disease
5.8 Congenital Heart Disease Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. Some of these lesions may be discovered later. prevalence of Chd
More informationCardiology Fellowship Manual. Goals & Objectives -Cardiac Imaging- 1 P a g e
Cardiology Fellowship Manual Goals & Objectives -Cardiac Imaging- 1 P a g e UNIV. OF NEBRASKA CHILDREN S HOSPITAL & MEDICAL CENTER DIVISION OF CARDIOLOGY FELLOWSHIP PROGRAM CARDIAC IMAGING ROTATION GOALS
More informationCongenital Heart Disease: Physiology and Common Defects
Congenital Heart Disease: Physiology and Common Defects Jamie S. Sutherell, M.D, M.Ed. Associate Professor, Pediatrics Division of Cardiology Director, Medical Student Education in Pediatrics Director,
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationCONGENITAL HEART DISEASE (CHD)
CONGENITAL HEART DISEASE (CHD) DEFINITION It is the result of a structural or functional abnormality of the cardiovascular system at birth GENERAL FEATURES OF CHD Structural defects due to specific disturbance
More informationHeart and Lungs. LUNG Coronal section demonstrates relationship of pulmonary parenchyma to heart and chest wall.
Heart and Lungs Normal Sonographic Anatomy THORAX Axial and coronal sections demonstrate integrity of thorax, fetal breathing movements, and overall size and shape. LUNG Coronal section demonstrates relationship
More informationDouble Outlet Right Ventricle with Anterior and Left-Sided Aorta and Subpulmonary Ventricular Septal Defect
Case Report Double Outlet Right Ventricle with Anterior and Left-Sided rta and Subpulmonary Ventricular Septal Defect Luciana Braz Peixoto, Samira Morhy Borges Leal, Carlos Eduardo Suaide Silva, Sandra
More informationAssessing Cardiac Anatomy With Digital Subtraction Angiography
485 JACC Vol. 5, No. I Assessing Cardiac Anatomy With Digital Subtraction Angiography DOUGLAS S., MD, FACC Cleveland, Ohio The use of intravenous digital subtraction angiography in the assessment of patients
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationCYANOTIC CONGENITAL HEART DISEASES. PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU
CYANOTIC CONGENITAL HEART DISEASES PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU DEFINITION Congenital heart diseases are defined as structural and functional problems of the heart that are
More informationEchocardiography in Adult Congenital Heart Disease
Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease CHD missed in
More informationThe Fetal Cardiology Program
The Fetal Cardiology Program at Texas Children s Fetal Center About the program Since the 1980s, Texas Children s Fetal Cardiology Program has provided comprehensive fetal cardiac care to expecting families
More informationDear Parent/Guardian,
Dear Parent/Guardian, You have indicated on school records that your child has an ongoing health problem that may require medication and/or treatment during the school day with rescue medication. Attached
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationThe role of intraoperative TOE in congenital cardiac surgery
The role of intraoperative TOE in congenital cardiac surgery Justiaan Swanevelder Dept of Anaesthesia Groote Schuur and Red Cross War Memorial Children s Hospitals University of Cape Town, South Africa
More informationData Collected: June 17, Reported: June 30, Survey Dates 05/24/ /07/2010
Job Task Analysis for ARDMS Pediatric Echocardiography Data Collected: June 17, 2010 Reported: Analysis Summary For: Pediatric Echocardiography Exam Survey Dates 05/24/2010-06/07/2010 Invited Respondents
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More information9/8/2009 < 1 1,2 3,4 5,6 7,8 9,10 11,12 13,14 15,16 17,18 > 18. Tetralogy of Fallot. Complex Congenital Heart Disease.
Current Indications for Pediatric CTA S Bruce Greenberg Professor of Radiology Arkansas Children s Hospital University of Arkansas for Medical Sciences greenbergsbruce@uams.edu 45 40 35 30 25 20 15 10
More informationpulmonary valve on, 107 pulmonary valve vegetations on, 113
INDEX Adriamycin-induced cardiomyopathy, 176 Amyloidosis, 160-161 echocardiographic abnormalities in, 160 intra-mural tumors similar to, 294 myocardial involvement in, 160-161 two-dimensional echocardiography
More informationAtlas of Practical Cardiac Applications of MRI
Atlas of Practical Cardiac Applications of MRI Atlas of Practical Cardiac Applications of MRI Guillcm Pons-LIado, MD. Director, Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i
More informationCoarctation of the aorta
T H E P E D I A T R I C C A R D I A C S U R G E R Y I N Q U E S T R E P O R T Coarctation of the aorta In the normal heart, blood flows to the body through the aorta, which connects to the left ventricle
More informationPamela Heggie, RN BN Clinic Coordinator Northern Alberta Adult Congenital Heart (NAACH) Clinic Mazankowski Heart Institute
Pamela Heggie, RN BN Clinic Coordinator Northern Alberta Adult Congenital Heart (NAACH) Clinic Mazankowski Heart Institute Brief Overview of Congenital Heart Disease Spectrum disorder Treatment & Impact
More informationSlide 1. Slide 2. Slide 3 CONGENITAL HEART DISEASE. Papworth Hospital NHS Trust INTRODUCTION. Jakub Kadlec/Catherine Sudarshan INTRODUCTION
Slide 1 CONGENITAL HEART DISEASE Jakub Kadlec/Catherine Sudarshan NHS Trust Slide 2 INTRODUCTION Most common congenital illness in the newborn Affects about 4 9 / 1000 full-term live births in the UK 1.5
More informationEchocardiography of Congenital Heart Disease
Echocardiography of Congenital Heart Disease Sunday, April 15 Tuesday, April 17, 2018 Ruth and Tristram Colket, Jr. Translational Research Building on the Raymond G. Perelman Campus Learn more: chop.cloud-cme.com
More informationMitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
More informationCongenital heart disease (CHD) is
Adults with Congenital Heart Disease: Multiple Needs of a Fast Growing Cardiac Patient Group MICHAEL A. GATZOULIS Royal Brompton Adult Congenital Heart Centre, National Heart & Lung Institute, London,
More informationCongenital heart disease in the neonate: results of
Archives of Disease in Childhood, 1983, 58, 137-141 Congenital heart disease in the neonate: results of surgical treatment E L BOVE, C BULL, J STARK, M DE LEVAL, F J Thoracic Unit, The Hospitalfor Sick
More informationIntroduction. Pediatric Cardiology. General Appearance. Tools of Assessment. Auscultation. Vital Signs
Introduction Pediatric Cardiology An introduction to the pediatric patient with heart disease: M-III Lecture Douglas R. Allen, M.D. Assistant Professor and Director of Community Pediatric Cardiology at
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationIndex. interventional.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Alagille syndrome, pulmonary artery stenosis in, 143 145, 148 149 Amplatz devices for atrial septal defect closure, 42 46 for coronary
More informationAnomalous Systemic Venous Connection Systemic venous anomaly
World Database for Pediatric and Congenital Heart Surgery Appendix B: Diagnosis (International Paediatric and Congenital Cardiac Codes (IPCCC) and definitions) Anomalous Systemic Venous Connection Systemic
More informationCongenital heart disease. By Dr Saima Ali Professor of pediatrics
Congenital heart disease By Dr Saima Ali Professor of pediatrics What is the most striking clinical finding in this child? Learning objectives By the end of this lecture, final year student should be able
More informationWhen is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영
When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 The Korean Society of Cardiology COI Disclosure Eun-Young Choi The author have no financial conflicts of interest to disclose
More informationCongenital Heart Disease
Congenital Heart Disease Mohammed Alghamdi, MD, FRCPC, FAAP, FACC Associate Professor and Consultant Pediatric Cardiology, Cardiac Science King Fahad Cardiac Centre King Saud University INTRODUCTION CHD
More informationList of Videos. Video 1.1
Video 1.1 Video 1.2 Video 1.3 Video 1.4 Video 1.5 Video 1.6 Video 1.7 Video 1.8 The parasternal long-axis view of the left ventricle shows the left ventricular inflow and outflow tract. The left atrium
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationPatent ductus arteriosus PDA
Patent ductus arteriosus PDA Is connecting between the aortic end just distal to the origin of the LT sub clavian artery& the pulmonary artery at its bifurcation. Female/male ratio is 2:1 and it is more
More informationThe first report of the Society of Thoracic Surgeons
REPORT The Society of Thoracic Surgeons National Congenital Heart Surgery Database Report: Analysis of the First Harvest (1994 1997) Constantine Mavroudis, MD, Melanie Gevitz, BA, W. Steves Ring, MD, Charles
More informationHow to Recognize a Suspected Cardiac Defect in the Neonate
Neonatal Nursing Education Brief: How to Recognize a Suspected Cardiac Defect in the Neonate https://www.seattlechildrens.org/healthcareprofessionals/education/continuing-medical-nursing-education/neonatalnursing-education-briefs/
More informationAdults With Congenital Heart. Disease. An Expanding Population. In this article:
Adults With Congenital Heart Disease An Expanding Population Continued progress in diagnosing and managing infants and children with congenital heart disease will likely result in a better prognosis and
More informationChildren with Single Ventricle Physiology: The Possibilities
Children with Single Ventricle Physiology: The Possibilities William I. Douglas, M.D. Pediatric Cardiovascular Surgery Children s Memorial Hermann Hospital The University of Texas Health Science Center
More informationSurvival Rates of Children with Congenital Heart Disease continue to improve.
DOROTHY RADFORD Survival Rates of Children with Congenital Heart Disease continue to improve. 1940-20% 1960-40% 1980-70% 2010->90% Percentage of children with CHD reaching age of 18 years 1938 First Patent
More informationAdult Congenital Heart Disease: The New Reality. Disclosures
Adult Congenital Heart Disease: The New Reality Kathryn Rouine-Rapp, MD Professor of Anesthesia Disclosures I have nothing to disclose 1 Outline Historic perspective Our reality Common lesions Guidelines
More informationEchocardiographic assessment in Adult Patients with Congenital Heart Diseases
Echocardiographic assessment in Adult Patients with Congenital Heart Diseases Athanasios Koutsakis Cardiologist, Cl. Research Fellow George Giannakoulas Ass. Professor in Cardiology 1st Cardiology Department,
More informationPaediatrics Revision Session Cardiology. Emma Walker 7 th May 2016
Paediatrics Revision Session Cardiology Emma Walker 7 th May 2016 Cardiovascular Examination! General:! Make it fun!! Change how you act depending on their age! Introduction! Introduce yourself & check
More informationThe Chest X-ray for Cardiologists
Mayo Clinic & British Cardiovascular Society at the Royal College of Physicians, London : 21-23-October 2013 Cases-Controversies-Updates 2013 The Chest X-ray for Cardiologists Michael Rubens Royal Brompton
More informationImplantation of Cardioverter Defibrillator After Percutaneous Closure of Atrial Septal Defect
The Ochsner Journal 10:27 31, 2010 f Academic Division of Ochsner Clinic Foundation Implantation of Cardioverter Defibrillator After Percutaneous Closure of Atrial Septal Defect Anas Bitar, MD, Maria Malaya
More informationJ Somerville and V Grech. The chest x-ray in congenital heart disease 2. Images Paediatr Cardiol Jan-Mar; 12(1): 1 8.
IMAGES in PAEDIATRIC CARDIOLOGY Images Paediatr Cardiol. 2010 PMCID: PMC3228330 The chest x-ray in congenital heart disease 2 J Somerville and V Grech Paediatric Department, Mater Dei Hospital, Malta Corresponding
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationMEDICAL MANAGEMENT WITH CAVEATS 1. In one study of 50 CHARGE patients with CHD, 75% required surgery. 2. Children with CHARGE may be resistant to chlo
CARDIOLOGY IN CHARGE SYNDROME: FOR THE PHYSICIAN Angela E. Lin, M.D. Teratology Program/Active Malformation Surveillance, Brigham and Women's Hospital, Old PBBH-B501, 75 Francis St., Boston, MA 02115 alin@partners.org
More informationCardiology Competency Based Goals and Objectives
Cardiology Competency Based Goals and Objectives COMPETENCY 1. Patient Care. Provide family centered patient care that is developmentally and age appropriate, compassionate, and effective for the treatment
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationWhen to implant an ICD in systemic right ventricle?
When to implant an ICD in systemic right ventricle? Département de rythmologie et de stimulation cardiaque Nicolas Combes n.combes@clinique-pasteur.com Pôle de cardiologie pédiatrique et congénitale Risk
More informationAtrial Septal Defects
Supplementary ACHD Echo Acquisition Protocol for Atrial Septal Defects The following protocol for echo in adult patients with atrial septal defects (ASDs) is a guide for performing a comprehensive assessment
More informationFoetal Cardiology: How to predict perinatal problems. Prof. I.Witters Prof.M.Gewillig UZ Leuven
Foetal Cardiology: How to predict perinatal problems Prof. I.Witters Prof.M.Gewillig UZ Leuven Cardiopathies Incidence : 8-12 / 1000 births ( 1% ) Most frequent - Ventricle Septum Defect 20% - Atrium Septum
More informationThe Double Switch Using Bidirectional Glenn and Hemi-Mustard. Frank Hanley
The Double Switch Using Bidirectional Glenn and Hemi-Mustard Frank Hanley No relationships to disclose CCTGA Interesting Points for Discussion What to do when. associated defects must be addressed surgically:
More information4a.i. 4a.ii. Form 12: Pre Transplant Status Report. Height and Weight. Status.
PHTS - Form : Pre Transplant Report Page of 5 Patient Details Hidden Show Show/Hide Annotations Stickies: Toggle All Toggle Open Toggle Resolved Form : Pre Transplant Report Print this Form t Started Was
More informationSupplemental Table 1. ICD-9 Codes for Diagnoses and Procedures
Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures ICD-9 Code Description Heart Failure 402.01 Malignant hypertensive heart disease with heart failure 402.11 Benign hypertensive heart disease
More informationADULT CONGENITAL HEART DISEASE. Stuart Lilley
ADULT CONGENITAL HEART DISEASE Stuart Lilley More adults than children have congenital heart disease Huge variety of congenital lesions from minor to major Heart failure, re-operation and arrhythmia are
More informationSince first successfully performed by Jatene et al, the
Long-Term Predictors of Aortic Root Dilation and Aortic Regurgitation After Arterial Switch Operation Marcy L. Schwartz, MD; Kimberlee Gauvreau, ScD; Pedro del Nido, MD; John E. Mayer, MD; Steven D. Colan,
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationCASE REPORT: DOUBLE ORIFICE MITRAL VALVE WITH CLEFT IN ANTERIOR LEAFLET OF DOMINANT VALVE IN AN AFRO-CARIBBEAN
CASE REPORT: DOUBLE ORIFICE MITL VAE WITH CLEFT IN ANTERIOR LEAFLET OF DOMINANT VAE IN AN AFRO-CARIBBEAN Disclosure: No potential conflict of interest. Received: 27.08.13 Accepted: 23.06.14 Citation: EMJ
More informationCongenital Heart Disease II: The Repaired Adult
Congenital Heart Disease II: The Repaired Adult Doreen DeFaria Yeh, MD FACC Assistant Professor, Harvard Medical School MGH Adult Congenital Heart Disease Program Echocardiography Section, no disclosures
More informationBurden of congenital heart diseases in a tertiary cardiac care institute in Western India: Need for a national registry
Original Article Burden of congenital heart diseases in a tertiary cardiac care institute in Western India: Need for a national registry ABSTRACT Objective: Congenital heart disease (CHD) is very common
More informationThe incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients
The Turkish Journal of Pediatrics 2008; 50: 549-553 Original The incidence and risk factors of arrhythmias in the early period after cardiac surgery in pediatric patients Selman Vefa Yıldırım 1, Kürşad
More informationEchocardiography in Congenital Heart Disease
Chapter 44 Echocardiography in Congenital Heart Disease John L. Cotton and G. William Henry Multiple-plane cardiac imaging by echocardiography can noninvasively define the anatomy of the heart and the
More informationPerioperative Management of DORV Case
Perioperative Management of DORV Case James P. Spaeth, MD Department of Anesthesia Cincinnati Children s Hospital Medical Center University of Cincinnati Objectives: 1. Discuss considerations regarding
More information2018 Guideline for the Management of Adults with Congenital Heart Disease
2018 Guideline for the Management of Adults with Congenital Heart Disease A Selection of Tables and Figures ACC.org/GMSACHD 2018 Guideline for the Management of Adults with Congenital Heart Disease A report
More informationAortography in Fallot's Tetralogy and Variants
Brit. Heart J., 1969, 31, 146. Aortography in Fallot's Tetralogy and Variants SIMON REES AND JANE SOMERVILLE From The Institute of Cardiology and National Heart Hospital, London W.J In patients with Fallot's
More informationT wo dimensional and Doppler echocardiography is being
F287 ORIGINAL ARTICLE Evaluation of echocardiography on the neonatal unit S Moss, D J Kitchiner, C W Yoxall, N V Subhedar... See end of article for authors affiliations... Correspondence to: Dr Subhedar,
More informationUptofate Study Summary
CONGENITAL HEART DISEASE Uptofate Study Summary Acyanotic Atrial septal defect Ventricular septal defect Patent foramen ovale Patent ductus arteriosus Aortic coartation Pulmonary stenosis Cyanotic Tetralogy
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationHeart and Soul Evaluation of the Fetal Heart
Heart and Soul Evaluation of the Fetal Heart Ivana M. Vettraino, M.D., M.B.A. Clinical Associate Professor, Michigan State University College of Human Medicine Objectives Review the embryology of the formation
More informationAdult Congenital Heart Disease T S U N ` A M I!
Adult Congenital Heart Disease T S U N ` A M I! Erwin Oechslin, MD, FRCPC, FESC Director, Congenital Cardiac Centre for Adults University Health Network Peter Munk Cardiac Centre / Toronto General Hospital
More informationfound that some patients without stenotic lesions had blood velocity or pressure measurement across the
Br Heart J 1985; 53: 640-4 Increased blood velocities in the heart and great vessels of patients with congenital heart disease An assessment of their significance in the absence of valvar stenosis STANLEY
More informationStructural heart disease in the newborn
Archives of Disease in Childhood, 1979, 54, 281-285 Structural heart disease in the newborn Changing profile: comparison of 1975 with 1965 TERUO IZUKAWA, H. CONNOR MULHOLLAND, RICHARD D. ROWE, DAVID H.
More informationCardiac Emergencies in Infants. Michael Luceri, DO
Cardiac Emergencies in Infants Michael Luceri, DO October 7, 2017 I have no financial obligations or conflicts of interest to disclose. Objectives Understand the scope of congenital heart disease Recognize
More information4 th Echocardiography Course on Congenital Heart Disease
4 th Echocardiography Course on Congenital Heart Disease The Hospital for Sick Children s Daniels Hollywood Theatre April 4 6, 2019 Course Directors: Luc Mertens, Mark Friedberg, Andreea Dragulescu Co-directors:
More informationCMR for Congenital Heart Disease
CMR for Congenital Heart Disease * Second-line tool after TTE * Strengths of CMR : tissue characterisation, comprehensive access and coverage, relatively accurate measurements of biventricular function/
More information